Multi-Resolution Foveated Laparoscope for Safer Minimally Invasive Surgery Project Summary Endoscopy has revolutionized patient care in the domain of minimally invasive surgery (MIS) and recently been applied to high-resolution molecular imaging for detection of early-stage disease. Laparoscopy is the foundation of MIS procedures, routinely performed in several specialties, and has demonstrated advantages over equivalent open procedures that include reduced pain, shorter recovery time and hospital stay time, and reduced costs. The current laparoscopic technologies, however, have a number of major limitations. One limitation is the inability to acquire both wide-angle and high-resolution images simultaneously through a single integrated probe. This shortcoming introduces issues when surgeons require both detailed close-up views and wide-angle overviews for spatial orientation and situational awareness. Currently, this limitation is addressed by manually moving the entire laparoscope in and out and requires a second trained assistant. It also introduces ergonomic conflicts, especially now with the recent development of single port access procedures with close grouping of the laparoscope and working instruments. Digital zooming has been attempted to address the need for both wide angle and high-magnification views but has been limited by the resulting loss of resolution. This proposal responds to this pressing challenge. By leveraging the advancements of optical technologies, we aim to develop an innovative laparoscope that can (1) simultaneously obtain both wide-angle- and high-magnification images of a surgical area in real-time in a single, fully integrated instrument; (2) yield ultra-high spatial resolution more than 3 times better than a conventional laparoscope at a close-up working distance; (3) automatically scan and engage the high-magnification probe to any sub-region of the surgical field through region-of-interest tracking capabilities; (4) vary the optical magnification of the high-resolution probe without the need of physically advancing or withdrawing the probe; and (5) maintain a low profile to minimize interfaces with surgical instruments. We overcome the limitations of existing laparoscopes by optically coupling a wide-angle system with an actively foveated, high-resolution probe. At a low magnification, the laparoscope will image a large surgical field with a field of view (FOV) with spatial resolution equivalent to a standard laparoscope, providing a stadium view. A sub-region of the field, which we call the foveated field, will then be imaged at a significantly higher magnification to visualize more detailed structure for diagnosis or surgical treatment. Both the level of optical magnification and the position of the foveated field can be optically through real-time optical tracking and zooming capabilities. In this project, we will aim to (1) develop prototype systems, (2) develop enabling utility software; and (3) test the imaging quality and task performance capabilities of our proposed multi- resolution foveated laparoscope for use in MIS procedures employing both simulated laparoscopic tasks and complex in vivo clinical testing. The proposed approach is innovative because it will optically couple a wide-angle probe with an actively foveated, high-resolution image probe that provides both continuously adjustable region of interest and optical magnification. The advantages are quite obvious. It preserves the benefits of a wide-angle, low resolution laparoscope and with the capability of simultaneous, embedded high-resolution imaging. While providing significantly advanced imaging capabilities, this multi-resolution laparoscope will also preserve the compactness of current, standard laparoscopes. If successful, we envision that an integrated multi-resolution laparoscope will impact the diagnostic, clinical, and technical aspects of MIS. The unique cost and resolution advantages of our proposed multi-resolution foveated laparoscope ensure that such a surgical instrument can be quickly translated into a host of clinical applications.